MOCK EXAM 1.txt

1. It is hypothesized that schizophrenia may be related to an excess of which neurotransmitter:
a) Serotonin
b) GABA
c) Dopamine
d) Glutamate

c. Dopamine

2. Structural abnormalities in the brains of patients with obsessive compulsive disorder have been identified in several areas. Which of the following areas have not been found to be affected?
a) Cingulate gyrus
b) Orbital frontal cortex
c) Substantia nigra
d) Caudate nucleus

c) Substantia nigra

3. A patient presents with quite limited spontaneous speech, an inability to repeat statements made by the examiner, yet an ability to follow instructions provided by the examiner. This patient may be suffering from:
A) Global AphasiaB) Brocas Aphasia
C) Wernickes Aphasia
D) Conduction Aphasia

B) Brocas Aphasia

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4. Another patient presents with quite fluent, spontaneous speech, yet an inability to repeat statements made by the examiner, and an ability to follow instructions provided by the examiner. This patient may be suffering from:

5. A 76 year old woman presents with marked confusion, disorientation, and impaired memory that reportedly became noticeable within the past week. Among the following choices, which is the most likely diagnosis?
a) Depression
b) Dementia
c) Delirium
d) Dystonia

9. A right-handed patient sustains a PCA infarct that results in damage to the left posterior white matter and the splenium of the corpus callosum, with relative gray matter sparing. Which of the following symptom clusters is most likely to occur?

14. Which of the following is a differentiating factor in comparing familial Alzheimers (in which a genetic link has been established) from the more common nonfamilial Alzheimers?

A) Core clinical/behavioral features
B) Post-mortem neuropathological changesC) Age of onset
d) None of the above (e.g., aside from genetics the two syndromes are identical)

C) Age of onset

Interestingly, other than age of onset, there are not
consistent clinical differences between familial and nonfamilial AD. Familial
cases tend to have earlier onset (middle adulthood vs over 65).

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15. If brain damage involves structures surrounding the cribiform plate, it is likely that which cranial nerve would be involved?

a) Olfactory
b) Optic
c) Facial
d) Hypoglossal

a) Olfactory

The olfactory nerve travels across the cribiform

plate of the ethmoid bone to synapse in the olfactory bulbs. The sense of smell may be lost following head

trauma due to damage to the olfactory nerves as they penetrate the olfactory

plate.

16. A patient who is unable to recognize his family members, or his doctor of many years, is likely suffering from ________. If this problem is the result of a unilateral disorder, it is likely that the lesion is in the ______ hemisphere.

A) Prosopagnosia, Right
B) Simultanagnosia, Left
C) Simultanagnosia, Right
D) Prosopagnosia, Left

A) Prosopagnosia, Right

Prosopagnosia is the inability to recognize known faces, and to learn new ones. Lesions are typically bilateral in the occipitotemporal cortex and underlying white matter; if unilateral, it results from right hemisphere lesions.

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17. Which of the following is not characteristic of multiple sclerosisA) Aphasia
B) Dysarthria
C) Tremor
D) Nystagmus

A) Aphasia

Page 354 in Kaufman “Since the cerebral cortical ‘gray matter’ which has no myelin is relatively spared, MS patients rarely develop signs of cerebral cortical dysfunction, such a seizures or aphasia.”

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18. Anomic aphasia is typically caused by damage to the following area of the left hemisphere:

A) Approximately 65% of all causes of dementia are reversibleB) Approximately 5% of all causes of dementia are reversible
C) Approximately 45% of all causes of dementia are reversible
D) Approximately 25% of all causes of dementia are reversible

B) Approximately 5% of all causes of dementia are reversible

“More than 50 different illnesses produce symptoms of dementia. Available studies indicate that, on average, 5% of all causes of dementia are reversible and 11% have some specific treatment available, although not typically resulting in symptom reversal. Kasniak, A. (2002). Dementia. In Encyclopedia of the human brain, Vol. 1. Elsevier.

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20. An examiner gives a patient the WASI while he is on an inpatient rehabilitation unit. The patient is then seen as an outpatient to track his recovery, where he is administered the WAIS-III. What sources of variability or error variance might affect his scores and obscure real changes in his functioning?

A) Malingering patients typically demonstrate more difficulties with memory than they do with attention
B) Any patient who is involved in a personal injury case or has a lawyer must be malingering
C) Malingering is detectable through face-to-face clinical interviews alone
D) Patients with genuine organic illnesses will not exaggerate their symptoms

A) Malingering patients typically demonstrate more difficulties with memory than they do with attention

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22. PTA, or Post Traumatic Amnesia, refers to:

A) The fact that most children cannot remember traumatic events that happened to them.
B) A period of time following a TBI in which the patient cannot remember what had happened to cause the injury.C) A period of time following a TBI in which new memories cannot be consistently formed.
D) The memory difficulties typically associated with Post-Traumatic Stress Disorder.

C) A period of time following a TBI in which new memories cannot be consistently formed.

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23. An individual with which type of dementia is most likely to show retrieval rather than retention deficits:

Criterion related validity is based on some external criterion which the researcher believes is another indicator of the same variable that a tests intends to measure.For example, the validity of a test of depression might reasonably be established by using it on a group of people who are receiving treatment for depression and comparing scores with a control group.

There are two types of criterion validity differing only in terms of the timing of the criterion :
Concurrent validity. This is the degree to which a test corresponds to an external criterion that is known concurrently (i.e. occurring at the same time). If the new test is validated by a comparison with a currently existing criterion, we have concurrent validity. Very often, a new IQ or personality test might be compared with an older but similar test known to have good validity already.

Predictive validity: This is the degree to which a test accurately predicts a criterion that will occur in the future. For example, a prediction may be made on the basis of a new intelligence test, that high scorers at age 12 will be more likely to obtain university degrees several years later. If the prediction is born out then the test has predictive validity.

On acute exposure to pesticides we see
headaches, blurred vision, restlessness, anxiety, depression, mental slowing,
slurred speech, and ataxia. For chronically exposed individuals, the most
frequent complaints are irritability, confusion and depression, as well as
attention, memory, and response speed deficits.

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33. In pediatric patients, about ____ % of brain tumors are in the posterior fossa and ___% are supratentorial.

A) 10, 90B) 70, 30
C) 30, 70
D) 50, 50

B) 70, 30

The posterior cranial fossa is part of the intracranial cavity, located between the foramen magnum and tentorium cerebelli. It contains the brainstem and cerebellum. This is the most inferior of the fossae. It houses the cerebellum, medulla and pons. Anteriorly it extends to the apex of the petrous temporal. Posteriorly it is enclosed by the occipital bone. Laterally portions of the squamous temporal and mastoid part of the temporal bone form its walls.

SupratentorialA word used by doctors and nurses to imply that a patient’s problems are all in their mind. The tentorium is a membrane just under the brain, so “supratentorial” refers to what is above that, namely the brain. This term can be used in front of the patient or patient’s family because it sounds like technical jargon.

Primary symptoms Gerstmann syndrome is characterized by four primary symptoms: Dysgraphia/agraphia: deficiency in the ability to write; Dyscalculia/acalculia: difficulty in learning or comprehending mathematics[2][3]Finger agnosia: inability to distinguish the fingers on the hand[2][3]Left-right disorientation[2][3]Causes

This disorder is often associated with brain lesions in the dominant (usually left) hemisphere including the angular and supramarginal gyri near the temporal and parietal lobe junction. There is significant debate in the scientific literature as to whether Gerstmann Syndrome truly represents a unified, theoretically motivated syndrome. Thus its diagnostic utility has been questioned by neurologists and neuropsychologists alike. The angular gyrus is generally involved in translating visual patterns of letter and words into meaningful information, such as is done while reading.

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35. Brocas aphasia is commonly accompanied by which of the following?

36. Which region of the brain seems to be involved both in habit learning and in OCD?
A) Dorsolateral Prefrontal CortexB) Caudate
C) Amygdala
D) Hippocampus

B) Caudate

The caudate nucleus is one of three basic structures that make up the basal ganglia. Along with the putamen and globus pallidus, as well in conjunction with the thalamus and two related structures (the substantia nigra and subthalamic nucleus), the caudate nucleus constitutes a system that is responsible largely for voluntary movement.[1] While this system has long been associated with motor processes due primarily to the basal ganglia’s role in Parkinson’s disease, there is mounting evidence that the structures that make up the basal ganglia –– the caudate nucleus included –– play important roles in various other nonmotor functions as well

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37. Which of the following is not one of the more common symptoms or signs of elevated intracranial pressure?

Among the more common potentially reversible causes are those due to prescription and nonprescription drug toxicity, metabolic disorder, brain tumors, subdural hematoma, and depression. The more common dementia types that are presently irreversible include Alzheimer’s disease, Parkinson’s disease, dementia with Lewy bodies, Huntington’s disease, frontotemporal dementias, vascular dementia, and traumatic brain injury.”

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39. Alexia refers to:

A) An aquired deficit in the interpretation of written language.
B) Impaired auditory processing of language
C) An inability to understand spoken language.
D) The lack of development of normal reading skills.

A) An acquired deficit in the interpretation of written language.

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40. Dysarthria, dysphagia and hypoactive jaw and gag reflexes without associated cognitive or emotional changes is known as:

Bulbar palsy refers to impairment of function of the cranial nerves IX, X, XI and XII, which occurs due to a lower motor neuron lesion either at nuclear or fascicular level in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem.

In contrast, pseudobulbar palsy describes impairment of function of cranial nerves IX-XII due to upper motor neuron lesions of the corticobulbar tracts in the mid-pons. For clinically evident dysfunction to occur, such lesions must be bilateral as these cranial nerve nuclei receive bilateral innervation.

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41. Use of a highly specific sign or symptom (e.g., contralateral neglect) in identifying brain damage will results in a high rate of:

45. Which of the following statements is true with regard to differentiating depression from dementia (Alzheimers/AD)?

A) Cognitive deficits in persons with depression are often more severe than in persons with AD.B) Persons with depression may exert less effort on the performance of neuropsychological tests.
C) Persons with depression are more likely to show impaired naming ability, verbal fluency, and visuospatial ability.
D) Persons with depression show memory retention deficits while persons with AD show retrieval deficits.

B) Persons with depression may exert less effort on the performance of neuropsychological tests.

According to the Fletcher et al chapter, when hydrocephalus occurs, the ventricles expand in a posterior to anterior direction and white matter is damaged. Due to these factors, the posterior regions of the brain may be particularly susceptible. This may partially explain the PIQ < VIQ findings… interestingly, children who show proportionally greater thinning of the posterior brain regions relative to anterior tend to show the PIQ < VIQ pattern. When the thinning is comparable, so too are the IQ scores. (Dennis et al, 1981).

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47. The brains major inhibitory neurotransmitter is _______, which is primarily affected by benzodiazepines and barbiturates.

A) DopamineB) GABA
C) Acetylcholine
D) Glutamate

B) Gaba

GABA is the chief inhibitoryneurotransmitter in the mammalian central nervous system. It plays a role in regulating neuronal excitability throughout the nervous system. In humans, GABA is also directly responsible for the regulation of muscle tone.[2]

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48. A lesion of Brodmanns area 44 in the dominant hemisphere is most closely associated with which of the following?

Brodmann area 44, or BA44, is part of the frontal cortex in the human brain. Situated just anterior to premotor cortex(BA6) and on the lateral surface, inferior to BA9.This area is also known as pars opercularis (of the inferior frontal gyrus). Together with left-hemisphere BA 45, the left hemisphere[1] BA 44 comprisesBroca's area a region involved in semantic tasks

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49. What pattern of IQ performance is typically observed in children with early-onset hydrocephalus?

A) VIQ > PIQB) PIQ > VIQ
C) VIQ = PIQ, with both being on average 10 points below age matched norms
d) VIQ = PIQ, with both being on average 10 points above age matched norms

B) PIQ > VIQ

This came from a chapter by Fletcher et al (???
which book). This finding is somewhat
controversial. On average, this is true, but there is substantial variability
between cases with shunted hydrocephalus.

Lesions of the temporal lobe can cause
contralateral superior quadranopia due to interruption of the lower portions of
the optic radiations. This is sometimes
referred to as the “pie in the sky” phenomenon.

Transcortical sensory aphasia (TSA) is a kind of aphasia that involves damage to specific areas of the temporal lobe of the brain, resulting in symptoms such as poor comprehension and naming, have fluent spontaneous speech and exhibit paraphasia. In all of these ways, TSA is very similar to a more commonly known language disorder,receptive aphasia. However, transcortical sensory aphasia differs from receptive aphasia (aka Wernicke's) in that patients still have intact repetition and exhibit echolalia, or the compulsive repetition of words

53. Which statement is false regarding cerebral palsy (CP)?

a) Injuries causing CP can occur pre-natally, post-natally, during infancy or early childhood.
b) When the cause of CP can be established, prematurity and low birthweight are usually implicated.
c) Epilepsy and mental retardation frequently co-occur with CP
d) Less than 5% of persons with CP have normal intelligence

d) Less than 5% of persons with CP have normal intelligence

54. Which of the following disorders has been most closely linked to degeneration of acetylcholine-synthesizing neurons in the basal forebrain?

Although Alzheimer’s is more than a simple
degeneration of the nucleus basalis of Meynert, this is a key site of
degeneration and likely accounts for the prominent early memory decline. The other disorders may also involve the
nucleus basalis of Meynert and/or cholinergic systems at one point or another,
but less directly or centrally.

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55. A lesion of the arcuate fasciculus would most likely cause the following subtype of aphasia:

56. Which treatments of tumors are generally not associated with mental status changes?

A) Medications such as opiates used for pain
B) Cranial (whole brain) radiotherapyC) All chemotherapies except methotrexate
D) Methotrexate, but generally not other chemotherapies

C) All chemotherapies except methotrexate

Most chemotherapies do not cause mental status
changes because they cannot cross the blood brain barrier. The exception is
methotrexate, which is administered intrathecally (into the subarachnoid space
usually by spinal tap). The benefit of this med is that it often protects from
leukemic cells entering the CNS… but it has a cost. It often induces
confusional states, LD’s, and ‘permanent intellectual impairment.’

A) The left hemisphere has more association cortex than the right hemisphere.
B) The right hemisphere has fewer interconnections than the left hemisphere.C) The left hemisphere has more gray matter/less white matter relative to the right hemisphere.
D) The two hemispheres have equal amounts of gray and white matter.

C) The left hemisphere has more gray matter/less white matter relative to the right hemisphere.

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60. A person who can not identify an object by touch may have:

A) Associative Agnosia
B) Alexia
C) AnomiaD) Astereognosis

D) Astereognosis

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61. Autopsy studies of dementia pugilistica typically reveal all of the following except:

63. Neglect can occur with lesions in all of the following areas except:

A) Right midbrain
B) Right frontal lobe
C) Right thalamus or basal gangliaD) Right internal capsule

D) Right internal capsule

The internal capsule is a unique location where a large number of motor and sensory fibers travel to and from the cortex. Damage of any kind in this location will cause some relatively unique findings that can allow you to localize the lesions to the internal capule by exam alone.

Symptoms and Signs:Weakness of the face, arm, and/or leg (pure motor stroke)Known as one of the classic types of lacunar infarcts, a pure motor strokeis the result of an infarct in the internal capsule.

Pure motor stroke caused by an infarct in the internal capsule is the most common lacunar syndrome.
Upper motor neuron signshyperreflexia, Babinski sign, Hoffman present, clonus, spasticity
Mixed sensorimotor stroke
Since both motor and sensory fibers are carried in the internal capsule, a stroke to the posterior limb of the internal capsule (where motor fibers for the arm, trunk and legs and sensory fibers are located) can lead tocontralateral weakness and contralateral sensory loss

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64. The structure involved in the master clock for circadian rhythms is the:

69. Which statement is true regarding the relationship between depression and dementia:

A) Cognitive symptoms associated with depression develop insidiously while cognitive symptoms associated with dementia develop rapidly. B) Depression decreases as the severity of dementia increases
C) CT and MRI reliably differentiate between depression and dementia
D) Both depression and dementia result in similar deficits in immediate recall and recognition on memory tests.

B) Depression decreases as the severity of dementia increases

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70. Which disorder is characterized by café au lait spots and Lisch nodules?

Options a, c, and d are all associated with
Gertsmann Syndrome, which would be compatible with the probable lesion
location. Right visual field defects are common in central alexia, which makes
sense unless the lesion is tiny.

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73. Which area of the brain has been shown to be most involved in response initiation and inhibition?

A) Myelination is complete by the end of the 7th month of gestation. B) Sensory areas of the brain are myelinated before motor areas.
C) Neural tube defects result from disruption of the myelination process
D) Striatal neurons are primarily involved in myelination.

B) Sensory areas of the brain are myelinated before motor areas.

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76. In lesions of the dominant inferior parietal lobe, centering on the angular gyrus, you would expect that the patient could:

A) Likely have some hemisensory loss and/or right homonymous visual field deficit

The angular gyrus is a region of the brain in the parietal lobe, that lies near the superior edge of the temporal lobe, and immediately posterior to thesupramarginal gyrus; it is involved in a number of processes related to language, number processing and spatial cognition, memory retrieval, attention, and theory of mind. It is Brodmann area 39 of the human brain.

The angular gyrus is the part of the brain associated with complex language functions (ie reading, writing and interpretation of what is written). Lesion to this part of the brain shows symptoms of the well-known Gerstmann syndrome: effects include finger tap agnosia, alexia (inability to read), acalcula (inability to use arithmetic operations), agraphia (inability to copy), and left-right confusion.

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77. The pattern of dementia with psychomotor slowing occurs in all except which of the following disorders?

The MCA is by far the largest cerebral artery and is the vessel most commonly affected by cerebrovascular accident. The MCA supplies most of the outer convex brain surface, nearly all the basal ganglia, and the posterior and anterior internal capsules.

The basilar artery is part of the blood supply system for the brain and central nervous system. It is formed where the two vertebral arteries join together at the base of the skull. The basilar artery carries oxygenated blood to the cerebellum, brain stem, and occipital lobes. Several arteries branch from the basilar artery at the upper portion of the brain stem, delivering blood to various parts of the brain. Two posterior cerebral arteries lead to the temporal lobes and the occipital cortices. A pair of superior cerebellar arteries, another pair of anterior inferior cerebellar arteries, and several paramedian and circumferential pontine arteries also branch from the basilar artery. Interruption of the blood flow through the basilar artery can lead to severe brain damage, organ malfunction, or death. An aneurysm, or bulge in the artery wall, may push that portion of the brain, or rupture and hemorrhage. A thrombosis, or blood clot, may block the artery and prevent blood from passing through. Because of its location and importance in providing oxygen and nutrients to vital portions of the brain, an aneurysm or thrombosis in the basilar artery is particularly dangerous.

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83. Alexia without agraphia is most likely due to damage to what region(s)?

A) Arcuate Fasciculus
B) Border zones of MCA including Brocas area
C) Angular gyrusD) Infarction of left posterior artery territory including the splenium of the corpus callosum

D) Infarction of left posterior artery territory including the splenium of the corpus callosum

The posterior cerebral artery(PCA) is one of a pair of blood vesselsthat supply oxygenated blood to the posterior aspect of the brain (occipital lobe)

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84. Research has shown that right-sided brain damage can lead to subtle language deficits in all of the following except?

85. Research has shown that individuals with mild cognitive impairment will develop dementia at a rate of?

A) 5-10% per year, at a greater prevalence than the general population in clinic samples
B) 25% per year, at a greater prevalence than the general population
C) 1-2 % per year, no different than the general population
D) <1% per year, at a lower rate than the general population

A) 5-10% per year, at a greater prevalence than the general population -- higher in clinic samples -- community rates not greatly higher than general population.

87. Which of the following is true about Lewy Body
A) Patients are responsive to l-dopa like Parkinsons dementia, but are insensitive to DA blocking agents.
B) It is a variant of Parkinson Dementia in which Lewy Bodies are present in the substantia nigra.
C) Auditory hallucinations are frequently present.D) It presents with Parkinsonian motor symptoms but the cognitive functioning more similarly looks like Alzheimers dementia.

D) It presents with Parkinsonian motor symptoms but the cognitive functioning more similarly looks like Alzheimers dementia.

Lewy body dementia, the second most common type of progressive dementia after Alzheimer's disease, causes a progressive decline in mental abilities.It may also cause visual hallucinations, which generally take the form of objects, people or animals that aren't there. This can lead to unusual behavior such as having conversations with deceased loved ones.Another indicator of Lewy body dementia may be significant fluctuations in alertness and attention, which may include daytime drowsiness or periods of staring into space. And, like Parkinson's disease, Lewy body dementia can result in rigid muscles, slowed movement and tremors.In Lewy body dementia, protein deposits, called Lewy bodies, develop in nerve cells in regions of your brain involved in thinking, memory and movement (motor control).

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88. Confabulation is frequently seen in all but which of the following conditions:

A) Lennox-Gastaut is a mixed seizure disorder in which the seizures are difficult to control, and status epilepticus is common.
B) Landau-Kleffner syndrome is characterized by an acquired aphasia, and seizures are most commonly generalized motor seizures.C) Febrile seizures occur in 2-4% of all children, and most go on to develop temporal lobe epilepsy.
D) Rolandic epilepsy occurs nocturnally and is usually in remission by age 15

C) Febrile seizures occur in 2-4% of all children, and most go on to develop temporal lobe epilepsy.

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90. Difficulty recalling events prior to amnesia onset is called ________________, while difficulty recalling previously learned information because new information interfered with it is called __________________.

A) Whole brain and partial brain radiation therapy is equally damaging in regards to cognitive impairment.
B) Older children are comparatively more vulnerable to radiation-induced cognitive impairment than younger due to plasticity issues.C) Children who have been treated with radiation therapy often present with cognitive impairment that can look like a nonverbal learning disability (i.e., performance based IQ more affected than verbal based IQ, particularly processing speed).
D) Chemotherapy, such as methotrexate, does not cause cognitive impairments as it is administered intrathecally and does not pass the blood/brain barrier.

C) Children who have been treated with radiation therapy often present with cognitive impairment that can look like a nonverbal learning disability (i.e., performance based IQ more affected than verbal based IQ, particularly processing speed).

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93. Which of the following is not an advantage of an MRI over CT?

A) It can be applied to intra- and extracranial arteries
B) There is no distortion from bone
C) MRI has greater resolution, being able to detect smaller objectsD) It detects hemorrhages and hematomas more accurately

D) It detects hemorrhages and hematomas more accurately

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94. Which of the following is not a typical means of determining premorbid IQ?

95. A neuropsychologist assesses a patient and finds an 18 point difference between the patients WAIS-III Full Scale IQ (FSIQ) score and WMS-III General Memory Index (GMI) score. What other information is crucial in order to find the statistical significance of this difference at the .05 level?

A) The patients FSIQ
B) The patients performance on memory recognition measures
C) The patients gender
D) The patients age

A) The patients FSIQ

FSIQ and GMI scores are highly correlated in
patients with IQ’s in the average range, but are less related for patients at
the lower and upper ends of the intelligence spectrum. It is not uncommon to see 25 point
differences between FSIQ and GMI scores in patients with very low or very high
IQ’s.

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96. In order to determine whether a change in a patients scores from Time 1 to Time 2 represents a clinically significant change, a neuropsychologist must take into account:

In anosognosia the
patient is unaware or does not admit to the condition, whereas in
anosodiaphoria the patient will admit to the impairment, but is not concerned. The other two options are unrelated agnosias

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99. Which statement is not true of Huntingtons Disease dementia:

A) is consistent with a subcortical dementiaB) it is correlated with severity of depression
C) it generally begins within one year of chorea
D) severity of dementia is correlated with caudate atrophy

B) it is correlated with severity of depression

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100. A 63-year-old man had a shower of emboli from the posterior circulation. Subsequently, he exhibits difficulty recognizing objects because of failure to perceive them. He is unable to draw objects, and he cannot match them to a sample. With what syndrome is he presenting?